Compression Therapy in Dermatology

The benefit of lower limb compression therapy is not limited to chronic venous insufficiency or/and lymphoedema. Thanks to its anti-edema and anti-inflammatory effects, compression therapy is considered a beneficial adjuvant therapy to treat atypical wounds, inflammatory dermatoses, cellulitis, and traumatic wounds in the absence of contraindications. Strict contraindications are limited to severe peripheral arterial disease and decompensated heart failure. The variability of commercially available compression materials and systems, such as short-stretch bandages, multi-component systems, zinc oxide bandages, medical adaptive compression systems, ulcer compression stockings or medical compression stockings, facilitates the adaptation of compression therapy to the individual needs of each patient. Compared to venous leg ulcers, low pressures of 20mmHg are often sufficient to treat dermatological disorders, with higher patient tolerance and compliance.

Pressure and stiffness of a new air-inflated compression wrap

OBJECTIVE

To report pressure and stiffness, in healthy volunteers, of a new compression device with an air bladder inflated by a pump to regulate pressure.

METHODS

The device was applied to 60 legs of 30 volunteers and set to exert different pressures of 20-50 mmHg. The exerted pressure was measured in supine and standing positions and during simple physical exercises; static stiffness index, dynamic stiffness index, and walking pressure amplitudes were calculated.

RESULTS

The exerted pressure showed a good correlation with the expected pressure at each pressure range. The stiffness indices were >10 mmHg in the range of inelastic materials. The device was considered very easy to apply and use by the testing researchers.

CONCLUSIONS

The device stiffness is in the same range as the inelastic bandages. Consequently, similar hemodynamic effectiveness could be expected but must be proved. Unlike inelastic bandages, this device was easy to apply and use.

Healing of Venous Leg Ulcers Influenced by Individual Aspects: Cluster Analysis in a Specialist Wound Management Clinic

INTRODUCTION/OBJECTIVE

Venous Leg Ulcers (VLU) present a challenging healing process. Attaining healing is a primary treatment objective, commonly pursued in Primary Health Care (PHC) or Specialist Wound Management Clinics. Our objective was to examine the association and interplay between sociodemographic, health, clinical, and care factors with the outcomes of VLU treatment in patients undergoing care at a Specialist Wound Management Clinic.

METHODS

Longitudinal, observational study took place in a center for the treatment of chronic injuries linked to PHC. The sociodemographic aspects, health status and habits, clinical and care aspects of patients with VLU were scrutinized over a 1-year period.

RESULTS

The sample comprised 103 participants, with some still under treatment (Treatment Group-TG/ n = 60) and others having achieved VLU healing (Healing Group-HG/ n = 43). An association between sociodemographic, health, clinical, and care factors and the healing outcome (HG) was identified. A moderate correlation was observed between factors predisposing to healing in the sociodemographic group and health habits. Notably, among sociodemographic factors, the older age group and improvements in health, particularly the reduced use of alcohol/smoking, appeared to exert the most significant influence on healing. Additionally, specialized service monitoring and the application of compression therapy were contributory factors.

CONCLUSIONS

These findings substantiate the hypothesis that sociodemographic, health, clinical, and care-related aspects are intertwined with VLU healing. Protective factors associated with healing interacted synergistically, fostering a positive outcome over one year of treatment.

A new compression stocking with well-defined pressure-a randomized controlled pilot study

BACKGROUND

To evaluate an innovative class I compression stocking with predetermined uniform pressure in comparison to a graduated class III compression stocking system, regarding edema reduction, interface pressure, and patient comfort.

METHOD

Twenty-five patients with chronic venous disease, were randomized: 12 to investigational stocking, 13 to comparator stocking. Data collected at baseline and after 14 days.

RESULTS

Edema was significantly equal reduced to follow-up; mean -129.0 cm3 (SD 105; p = .004, Class I) and -223.7 cm3 (SD 120; p = .002, Class III), respectively. The investigational stocking lost significantly less compression pressure than the comparator stocking (p ≤ .013). Participants in both groups perceived significant improvement regarding leg heaviness, leg swelling, and feelings of tightness and tingling (p ≤ .016).

CONCLUSION

The innovative investigational class I stocking appears to offer similar edema reduction and benefits to the comparator class III stocking. However, a larger and prolonged study is required. The study was registered in the ISRCTN-registry, ISRCTN17356077, https://www.isrctn.com/ISRCTN17356077.

Compression therapy in dermatology

Compression therapy is a conservative therapy that can be used in many patients with dermatological conditions, especially those associated with edema. In addition to its well-established use in venous and lymphatic disorders, there is increasing evidence that compression therapy supports the healing of inflammatory dermatoses. The presence of edema, regardless of its etiology, is an indication for the use of compression therapy. Nowadays, a variety of materials and treatment options are available for compression therapy, each with their own advantages and disadvantages. Often, compression therapy with low resting pressures is sufficient for effective therapy and is better tolerated by patients. The main contraindications to compression therapy are advanced peripheral arterial disease and decompensated heart failure. Individual factors and economic considerations should be taken into account when deciding on compression therapy with the patient. Patient self-management should be encouraged whenever possible. This requires education and support tools.

Kompressionstherapie in der Dermatologie

Die Kompressionstherapie ist eine konservative Therapie, die bei vielen Patienten mit dermatologischen Krankheiten durchgeführt werden kann, insbesondere wenn diese mit Ödemen assoziiert sind. Neben den wissenschaftlich sehr gut belegten Indikationen bei venösen und lymphatischen Erkrankungen, gibt es auch zunehmend wissenschaftliche Hinweise, dass durch die Kompressionstherapie die Abheilung entzündlicher Dermatosen unterstützt wird. Wenn Ödeme vorliegen, handelt es sich, unabhängig von deren Genese, um einen Einsatz im Rahmen der Zulassung der Kompressionstherapie.

Für die Kompressionstherapie stehen heute verschiedene Materialien und Versorgungsoptionen mit systemspezifischen Vor‐ und Nachteilen zur Verfügung. Oft ist eine Kompressionstherapie mit niedrigen Ruhedruckwerten für einen Therapieerfolg ausreichend und wird von den Patienten besser toleriert. Als wichtigste Kontraindikationen der Kompressionstherapie sind die fortgeschrittene periphere arterielle Verschlusskrankheit und die dekompensierte Herzinsuffizienz zu beachten.

Bei der gemeinsam mit dem Patienten getroffenen Entscheidung für eine Kompressionstherapie, sollten individuelle Faktoren und wirtschaftliche Aspekte berücksichtigt werden. Wann immer möglich, ist ein Selbstmanagement des Patienten zu unterstützen. Hierfür sind Edukation und Hilfsmittel erforderlich.

[Classification and nomenclature of current materials for compression therapy]

Compression therapy has been an essential part of conservative therapy for people with chronic wounds and edema of the lower extremities for hundreds of years. The initiated therapy can be divided into the decongestion phase, maintenance phase, and prevention. The choice of the respective compression materials is based, among other factors, on these phases, the clinical stage and symptoms, the needs of the affected person and their physical abilities. Today, a wide range of different materials and methods are available for compression therapy. Thus, it is increasingly difficult to keep an overview of these treatment options, especially since the nomenclature used by the manufacturers is often inconsistent. Thus, the materials and methods for compression therapy currently available in German-speaking countries and their clinical indications are described in this review article. In addition, a uniform nomenclature is proposed, on the basis of which an appropriate exchange between all those involved in the care of people with compression therapy is guaranteed.

Statischer Stiffness-Index von zwei Multikomponenten-Bandagen-Kompressionssystemen: Ergebnisse einer randomisierten kontrollierten Studie an gesunden Probanden

Zweck Vergleich der Leistung von zwei Mehrkomponenten-Kompressionssystemen.

Methoden In dieser randomisierten, kontrollierten Studie wurden beide Beine von 25 gesunden Probanden nach dem Zufallsprinzip entweder mit einem Kompressionssystem der neuen Generation (UrgoK1, eine einzige Binde) oder einem etablierten System (UrgoK2, zwei Binden) als Kontrolle bandagiert. Beide Systeme wurden Tag und Nacht getragen. Arbeits- und Ruhegrenzflächendruck wurden unmittelbar nach dem Anlegen und nach 4 h, 24 h, 48 h und 72 h gemessen und der Static Stiffness Index (SSI) berechnet.

Ergebnisse Nach 4 Stunden wurden mit beiden Systemen ähnlich hohe Arbeitsdrücke und mäßige Ruhedrücke registriert. Im Zeitverlauf folgten die Druckänderungen und des SSI den gleichen Kurven. Nach 48 h wurde ein SSI ≥ 10 mmHg bei 88 % der getesteten und 76 % der Kontrollsysteme erreicht, was die Nichtunterlegenheit des Testsystems bestätigt (p = 0,016). Beide Systeme wiesen gute Halteeigenschaften auf und waren gut verträglich, aber das getestete System wurde von der Mehrheit der Probanden als deutlich angenehmer empfunden und schließlich dem Kontrollsystem vorgezogen.

Schlussfolgerung Das neue Kompressionssystem erreichte ähnliche Leistungen wie die Kontrolle, aber seine bessere Akzeptanz könnte ein Vorteil für die Patientencompliance sein. Diese vielversprechenden Ergebnisse müssen in einer klinischen Studie an Patienten mit Unterschenkelulcera und/oder Ödemen bestätigt werden.

In-vivo-Druckmessungen zum Vergleich medizinischer adaptiver Kompressionssysteme mit maßangefertigter Flachstrick-Kompressionsversorgung

Hintergrund Die in der Erhaltungsphase der komplexen physikalischen Entstauungstherapie notwendige Kompressionstherapie kann anstelle von Flachstrick-Kompressionsstrümpfen (FS) auch mit vom Patienten selbst anzulegenden Bandagen erfolgen, den sogenannten medizinischen adaptiven Kompressionssystemen (MAK).

Methoden MAK und FS wurden mittels In-vivo-Druckmessungen unter der von Probanden selbst angelegten Kompression direkt verglichen. Dazu wurden Drücke über Picopress-Messgeräte und Sensoren (Microlab Elettronica, Italien) an n = 30 Patienten mit beidseitigen, symmetrischen, lymphostatischen Ödemen der Unterschenkel erfasst. FS und MAK wurden seitenrandomisiert zugewiesen. Nach Standardeinweisung und initialen Druckmessungen beider Systeme wurden MAK im Zeitverlauf von 2 und 4 h Tragedauer erneut gemessen. Static-Stiffness-Index (SSI) sowie Druckgradienten der Messhöhen B1-C wurden berechnet.

Ergebnisse MAK zeigen Ruhedruckwerte und SSI im therapeutischen Bereich, die signifikant höher ausfallen als bei FS (p < 0,01 bzw. p < 0,001). MAK erreichen signifikant höhere maximale Arbeitsdrücke (p < 0,001). Die Ruhedruckwerte von MAK zeigen nach 2 und 4 h, ohne Nachjustieren, keinen relevanten Druckabfall. Die mittleren Druckgradienten, bezogen auf die Messhöhen B1-C, unterscheiden sich nicht signifikant zwischen den Methoden.

Diskussion Die mit MAK erreichten Druckparameter untermauern deren therapeutische Effektivität. Die Anwendung von MAK ist auch ohne Nachjustieren druckstabil. Die Anwendung (Selbstanlage) kann als therapeutisch wirksam eingestuft werden. Eine gute Einweisung der Patienten ist jedoch bedeutsam.

Increasing competence in compression therapy for venous leg ulcers through training and exercise measured by a newly developed score-Results of a randomised controlled intervention study

Compression therapy with short-stretch bandages is the most common treating option for patients with venous leg ulcers in the decongestion phase in Germany. This randomised controlled intervention study examined whether a training is suitable to sustainably improve the skills of health care professionals. Altogether 55 nurses from hospitals and outpatient care participated. They were randomly assigned to case and control groups. Participants' abilities to properly apply a compression bandaging were assessed before and after a training session as well as after 1 and 3 months using a newly developed score (CCB score) based on six control parameters (CPs): padding, starting point, heel inclusion, heart direction, pressure at forefoot (A) and calf base (B1). After training, a significant increase in competence was observed, which only decreased non-significantly over the observation period: The average CCB score was 2.796 at V0, 4.89 at V1, 4.88 at V2, and 4.66 at V3. The CPs for pressure at A and B1 were met by a maximum of 42.6 and 43.6%, respectively, at all timepoints. The CP starting point was fulfilled by at least 61.7% after training, the CPs heart direction, heel and underpadding by at least 89.4, 96.4, and 97.9%, respectively. As a result of our study, it can be concluded that training improves the ability of users to apply compression bandagings, but one-off training does not appear to be suitable to improve the ability to apply compression bandagings with a therapy-relevant pressure. Therefor more training especially with pressure measuring devices would be necessary.

A randomised controlled clinical trial comparing the effectiveness of bandaging compared to the JuxtaCures™ device in the management of people with venous ulceration: Feasibility study

INTRODUCTION

The mainstay of treatment for venous ulceration remains compression therapy. Velcro Wrap devices are being increasingly used in these patients despite limited evidence. This feasibility study aimed to compare standard bandaging to the JuxtaCures™ Velcro wrap device.

METHODS

A single centre, unblinded RCT compared participants with venous ulceration randomised to either the JuxtaCures™ device or short stretch bandaging. Participants were followed up for 26 weeks.

RESULTS

160 participants were screened with 40 randomised. 3 participants in bandaging and 1 in JuxtaCures™ didn't complete the study. 60% in JuxtaCures™ healed v 55% in bandaging despite larger ulcers in the JuxtaCures™ arm (9.33 cm² v 6.97 cm²). There was no significant difference in time to healing (12.17 v 13.64 weeks). JuxtaCures™ showed improved ulcer reduction for those that didn't heal (14.91-5.00 cm² v 14.20-8.62 cm²; P = 0.06). JuxtaCures™ had more consistent sub-bandage pressure dropping from 39-36 mmHg versus 41-25 mmHg in bandaging between application and removal (P < 0.001). Quality of life (EQ5D) was improved in JuxtaCures at 3 months (mean difference 0.14, p = 0.04), but not at 1 and 6 months, or in disease specific quality of life. Cost was lower in JuxtaCures™ £842.47 v £1064.68. Duration of appointment was significantly shorter in JuxtaCures™ (41 minutes v 53 minutes; P = 0.003).

CONCLUSION

This study has shown the feasibility and necessity of running a multicentre trial to evaluate the use of Velcro wrap devices for venous ulceration. It highlights the potential benefits of more consistent pressure, increased self-care, and potential with regards to ulcer healing, cost, nursing resource and quality of life.

Kikuhime Device in the Management of Venous Leg Ulcers

The effectiveness of compression therapy in the treatment of venous leg ulcers has been confirmed in many scientific studies. The healing process depends on many of its parameters, such as the type of compression bandages, their elastic properties and sub-bandage pressure. However, there is no standard protocol that would ensure success for all patients. A pressure of about 83 mmHg provides complete compression for both superficial and deep veins; however, applying compression bandages under such high pressure is a difficult task, even for experienced therapists. Here, we present the case of a 61-year-old woman with approximately 2.5-year-old venous ulcer in her left leg due to chronic venous insufficiency (CVI). Our study aimed to show that routine pressure control at each bandage renewal using the Kikuhime device, as well as their twice daily application in the first week of therapy reduced the healing time of a venous leg ulcer with an area of about 20 cm² to four weeks.

Medizinische Adaptive Kompressionssysteme sind Flachstrick-Kompressionsstrümpfen in der KPE Phase II nicht unterlegen

Hintergrund Medizinische Adaptive Kompressionssysteme (MAK) sind mit Klettverschlüssen adjustierbare Kompressionsbandagen. Diese erweitern das Spektrum der therapeutischen Optionen in der komplexen physikalischen Entstauungstherapie (KPE). Die Studienlage zu MAK ist spärlich, es werden Vorteile in der der KPE Phase I beschrieben. Über die Durchführbarkeit und Sicherheit der Anwendung von MAK in der KPE Phase II existiert keine belastbare Evidenz.

Methoden Prospektive, randomisierte Nichtunterlegenheitsstudie. Probanden mit symmetrischen lymphostatischen Ödemen der Unterschenkel (n=30) wurden parallel mit neu angepasster Flachstrick-Kompression (FS) und MAK 3 Tage lang behandelt. Primäres Outcome waren die perometrisch gemessenen Volumeneffekte der MAK im Vergleich mit der Referenztherapie (FS). Zudem wurden die Anwendungssicherheit und die Handhabung (Patientenperspektive) überprüft.

Ergebnisse MAK sind, auch ohne regelmäßiges Nachjustieren, der Referenztherapie mit FS in der KPE Phase II nicht unterlegen (Vergleich der Differenzen der Volumeneffekte; p=0,163; 95%-KI [−38,2;+6,8] bei einem apriori definierten Äquivalenzbereich von±50 ml). MAK zeigten keine Nebenwirkungen. Patienten berichten im Vergleich mit FS ein signifikant leichteres An- und Ablegen der MAK bei vergleichbarem Tragekomfort.

Schlussfolgerung Die Daten belegen die Nichtunterlegenheit von MAK gegen die Referenztherapie mit FS. MAK können in der Erhaltungstherapie von lymphostatischen Erkrankungen als alternative Kompressionstherapie eingesetzt werden. Die Anwendung (Selbstanlage) kann als sicher eingestuft werden. Eine gute Einweisung von Patienten ist bedeutsam. Patienten mit Schwierigkeiten in der Handhabung von Kompressionsstrümpfen beim An- und Ausziehen können von MAK profitieren. Patienten mit sehr ausgeprägten Ödemen müssen während der MAK-Nutzung gegebenenfalls größere Schuhe tragen. Studien mit längeren Beobachtungsdauern sollten folgen.

[Importance of adequate pressure in compression therapy : Basis for successful treatment]

BACKGROUND

The pressure exerted by a compression device on a part of the body corresponds to the dosage of the compression therapy. Therefore, the pressure course under compression materials should be investigated in different clinical situations.

MATERIAL AND METHODS

Pressure measurements were carried out under different compression materials in lying, standing and walking positions within the framework of training, self-experimentation and in patients with venous leg ulcers.

RESULTS

The results showed that the pressure varied considerably depending on the material used, the firmness of application, the local configuration (body position) and the time interval between applications. A loss of pressure occurred under each compression therapy, especially under inelastic short-stretch material, mainly due to movement and edema reduction. This pressure loss is decisive for the timing of dressing changes and a reason for the good tolerance of high-pressure levels in mobile patients.

CONCLUSION

Low pressures are particularly suitable for edema reduction. Hemodynamic effects require higher pressures (60-80 mmHg). For this purpose, inelastic materials are preferred which enable lower pressures when lying down (40-60 mmHg). As compression bandages are too loosely applied by many users, pressure indicators on bandages or adaptive bandages with templates are helpful to apply the material with the correct pressure. As a consequence of these findings it is postulated that, at least in studies comparing different compression media, pressure measurements should be carried out in the future, whereby the measuring point and body position should be documented.

[Compression devices for decongestion therapy : A cross-sectional observational survey of handling, pressure, and comfort]

BACKGROUND

If compression bandaging is not performed in a professional manner, the objectives of the therapy may not be achieved and side effects or complications may result.

OBJECTIVES

This cross-sectional observational survey examines the handling of the treatment options: short-stretch bandages with padding, multicomponent compression systems, and adaptive compression bandages.

PARTICIPANTS AND METHODS

During several training sessions on the topic of compression therapy, 137 participants performed compression bandagings on each other. In this regard, they were asked to achieve a predetermined pressure range (short-stretch bandages: 50-60 mm Hg, multicomponent compression systems: 40-50 mm Hg, adaptive compression bandage: 35-45 mm Hg). To evaluate the efficiency, the time used for application, the achieved pressure value, and the comfort were determined.

RESULTS

Of the 302 bandagings (n = 137 participants), 28.4% lay within the given target pressure value range. This included 11.2% of performed short-stretch bandages, 35.2% of multicomponent compression systems, and 85.0% of adaptive compression bandages. Significant differences in the mean deviations are found between the treatment options. The bandage was described as being comfortable by 37.7% of users of short-stretch bandages with padding, by 65.0% of those wearing a multicomponent compression system, and by 94.6% of participants with an adaptive compression bandage.

CONCLUSIONS

In practice, short-stretch bandages are still the most frequently used care option for the creation of a phlebological compression bandage. In this survey, they proved to be unsafe, time-consuming, and uncomfortable in relation to other treatment options. Multicomponent compression systems and adaptive compression bandages are treatment options that may be a contemporary alternative which also bares more comfort for the patient.

Controlling compression bandaging pressure in leg ulcer research trials: A summary of the literature

Compression bandaging remains the ‘gold standard’ intervention for the treatment of venous leg ulcers. Numerous studies have investigated the effect of a large variety of compression bandaging techniques and materials on venous leg ulcer healing. However, the majority of these studies failed to monitor both actual bandage application pressures and the bandaging competency of participating clinicians. A series of literature searches to explore the methods, practices, recommendations and results of monitoring compression bandaging pressures in leg ulcer research trials were undertaken. This included investigating the reliability and validity of sub-bandage pressure monitors and the degree to which compression bandaging achieves the recommended sub-bandage pressure. The literature revealed inconsistencies regarding the monitoring of sub-bandage pressure and in sub-bandage pressures produced by clinicians. This creates difficulties when comparing study outcomes and attempting to develop evidence-based practice recommendations.

Compression therapy in patients with venous leg ulcers

Wund-D.A.CH. is the umbrella organization of the various wound care societies in German-speaking countries. The present consensus paper on practical aspects pertinent to compression therapy in patients with venous leg ulcers was developed by experts from Germany, Austria, and Switzerland. In Europe, venous leg ulcers rank among the most common causes of chronic wounds. Apart from conservative and interventional wound and vein treatment, compression therapy represents the basis of all other therapeutic strategies. To that end, there are currently a wide variety of materials and systems available. While especially short-stretch bandages or multicomponent systems should be used in the initial decongestion phase, ulcer stocking systems are recommended for the subsequent maintenance phase. Another - to date, far less common - alternative are adaptive Velcro bandage systems. Medical compression stockings have proven particularly beneficial in the prevention of ulcer recurrence. The large number of treatment options currently available enables therapists to develop therapeutic concepts geared towards their patients' individual needs and abilities, thus resulting in good acceptance and adherence. Compression therapy plays a crucial role in the treatment of patients with venous leg ulcers. In recent years, a number of different treatment options have become available, their use and application differing among German-speaking countries. The present expert consensus is therefore meant to outline concrete recommendations for routine implementation of compression therapy in patients with venous leg ulcers.

What is the existing evidence supporting the efficacy of compression bandage systems containing both elastic and inelastic components (mixed-component systems)? A systematic review

AIMS AND OBJECTIVES

To analyse current evidence on the efficacy of bandage systems containing both elastic and inelastic components (mixed-component systems).

BACKGROUND

International consensus on the efficacy of types of compression systems is difficult to achieve; however, mixed-component systems are being promoted as combining the best properties of both elastic and inelastic bandage systems and increasingly being used to treat venous leg ulcers in practice.

DESIGN

A systematic literature review.

METHODS

Search terms such as venous leg ulcer, varicose ulcer, leg ulcer, compression, bandage, elastic, inelastic, short stretch, healing rate, interface pressure, mixed component, two-layer, four-layer and multi-layer were used in database and hand searches in several combinations. Limits were set for years 2005-March 2015 and English-language publications.

RESULTS

A total of 475 studies were identified at initial search, and following elimination from abstract and title, this was reduced to 7. A further study was identified on Google Scholar, bringing the final number of studies fitting inclusion criteria to 8. The following subgroups relating to outcomes of efficacy were identified: ulcer healing, maintenance of interface pressure, slippage, ease of application and patient quality of life.

CONCLUSIONS

Mixed-component systems were found to have comparable ulcer healing rates to alternative compression systems and be easy to apply; have similar abilities to maintain pressure as four-layer bandages and better abilities than short-stretch bandages; have less slippage than alternative systems; and to be significantly associated with several favourable quality of life outcomes. Clinician skill in bandage application was an uncontrolled variable in all eight papers included in the review, which may limit reliability of findings.

RELEVANCE TO CLINICAL PRACTICE

This review synthesises existing evidence on the efficacy of mixed-component systems and encourages clinicians to regard them as an effective alternative to purely elastic or inelastic compression systems. Additionally, it highlights the importance of clinician skill in bandage application as a crucial determinant of effective compression.

Stress-memory polymeric filaments for advanced compression therapy

Revelation of stress-memory behavior in smart polymeric filaments and its implications for compression stockings for advanced compression management.

Measurement of distal limb sub-bandage pressure over 96 hours in horses

REASONS FOR PERFORMING STUDY

Currently, there is no objective information quantifying pressures exerted by distal limb bandages.

OBJECTIVES

To quantify the pressure exerted by each compression layer, a polo wrap (DLP), a compression bandage (DLC), and to measure the effect of time on sub-bandage pressure.

STUDY DESIGN

Longitudinal observational experiment.

METHODS

A DLC construct included a cotton roll compressed with brown gauze and elastic layers and the DLP construct included a pillow pad compressed by a cloth wrap. Dorsal and lateral sensors were placed on the mid-metacarpus. In healthy horses, sub-bandage pressures were recorded during application (n = 8) and at scheduled time points over the 24 (n = 9) and 96 h periods (n = 8). A generalised linear model was used to evaluate associations between pressure and sensor location, bandage type and time (P<0.05).

RESULTS

For the DLC, dorsal and lateral sensor pressures were 187 mmHg (95% CI 185-189 mmHg) and 142 mmHg (95% CI 133-151 mmHg). Combined sensor pressure after application of the brown gauze was 80 mmHg (95% CI 75-85 mmHg) and rose to 165 mmHg (95% CI 160-170 mmHg) after the elastic layer. Combined pressure at the end of the 96 h period was 135 mmHg (95% CI 123-147 mmHg). For the DLP bandage, location but not time was significant. Combined pressures ranged between 75 mmHg (95% CI 53-97 mmHg) and 85 mmHg (95% CI 63-107 mmHg).

CONCLUSIONS

Pressure distribution was not uniform. The DLP pressures were maintained for a 24 h period. The DLC maintained high pressures for 96 h, but a significant decrease in pressure occurred between 6 and 12 h. Providing there are no other reasons to change a bandage, a 4 day interval between bandages may be appropriate if maintaining distal limb compression is the principal indication.

Adjustable Velcro Compression Devices are More Effective than Inelastic Bandages in Reducing Venous Edema in the Initial Treatment Phase: A Randomized Controlled Trial

OBJECTIVE/BACKGROUND

The objective of this study was to compare the efficacy and comfort of inelastic bandages (IBs) and adjustable Velcro compression devices (AVCDs) in reducing venous leg edema in the initial treatment phase.

METHODS

Forty legs from 36 patients with untreated venous edema (C3EpsAsdPr) were randomized to two groups. Patients in the first group received IBs (n = 20) and those in the second AVCDs (n = 20). Both compression devices were left on the leg day and night, and were renewed after 1 day. Patients in the AVCD group were asked to re-adjust the device as needed when it felt loose. Leg volume was calculated using the truncated cone formula at baseline (T0), after 1 day (T1) and after 7 days (T7). The interface pressure of the two compression devices was measured by an air filled probe, and the static stiffness index calculated after applying compression at T0 and T1, and just before removal of compression on T1 and T7. Patient comfort with regard to the two compression systems was assessed by grading signs and symptoms using a visual analog scale.

RESULTS

At T1, the median percent volume reduction was 13% for the IB group versus 19% for the AVCD group; at T7 it was 19% versus 26%, respectively (p < .001). The pressure of the IBs was significantly higher compared with the AVCDs at T0 (63 vs. 43 mmHg) but dropped by > 50% over time, while it remained unchanged with AVCDs owing to the periodic readjustment by the patient. Comfort was reported to be similar with the two compression devices.

CONCLUSION

Re-adjustable AVCDs with a resting pressure of around 40 mmHg are more effective in reducing chronic venous edema than IBs with a resting pressure of around 60 mmHg. AVCDs are effective and well tolerated, not only during maintenance therapy, but also in the initial decongestive treatment phase of patients with venous leg edema.